NHS Test and Trace


NHS Test and Trace was a government-funded service in England, established in 2020 to track and help prevent the spread of COVID-19. The programme was part of the UK Health Security Agency; the service and the agency were headed by Jenny Harries.
The service was the responsibility of the Secretary of State for Health and Social Care and the Minister of State for Social Care. It was then devolved to the Parliamentary Under-Secretary of State for Innovation at that ministry. The initial budget for the service was £15billion, rising to £22bn in November 2020, and a further £15bn was allocated for 2021–2022 to bring the total for the two years to £37bn. Routine contact tracing was halted on 24 February 2022 when the service was closed.
The service provided temporary sites where samples were taken from individuals, the samples were then processed at a newly created network of laboratories, and the results were communicated; infected people were instructed to isolate themselves from others and asked to provide details of their recent close contacts, who are also told to isolate. Almost all of the work was outsourced to consultants and contractors, although some of the laboratories involved other government bodies and universities. NHS Test and Trace was separate from the pre-existing infection control function of Public Health England, which worked with NHS laboratories.

Creation

During the early stages of the COVID-19 pandemic, contact tracing was carried out by Public Health England, working with local authorities; PHE was an agency of the Department of Health and Social Care and not part of the NHS. Tracing efforts largely ceased on 12 March 2020 in view of the wide spread of infection in the population. Around the same time, testing NHS patients and staff was made a priority, and took all available test capacity.
The new agency was announced by Matt Hancock, the then Secretary of State for Health and Social Care, in April 2020 and began operations towards the end of May. It was led by Baroness Dido Harding, a Conservative peer and businesswoman, until the establishment of the UK Health Security Agency in April 2021.

Overview

NHS Test and Trace's remit was to find people who had come into close contact with those infected by the virus, thus enabling the lifting of blanket lockdown restrictions and a potential shift towards more localised measures were they be required. The organisation employed a team of 25,000 contact tracers who contacted people who have newly tested positive for COVID-19 and asked them about their recent movements, before identifying others they may have come into contact with. Those people were then required to go into self-isolation for ten days.
The contact tracers were employed by Serco, who engaged subcontractors – 29 of them in September 2020. Serco were paid £108million for the first phase of the work, up to late August 2020. The call centre was operated by American specialists Sitel, who were paid £84M for the first phase. In November 2020, Dido Harding described it as "the largest outbound calling centre in the UK". Software from Salesforce was supplied by IBM under a Strategic Sales Solution contract worth around £25M for 2020–21.
In late September and early October 2020, an Excel row-limit error in England's case-handling pipeline meant 15,841 positive cases were not promptly referred to contact tracing. This deficiency in the programme created a large-scale natural experiment which was later used by researchers to show that timely tracing substantially reduced subsequent infections and deaths.
All components – administering tests, processing samples in laboratories, and contact tracing – were contracted to private companies. Multinational consultants Deloitte handle testing logistics, including collection of statistics, and in turn appointed outsourcing companies Serco, Mitie, G4S and Sodexo, together with the Boots pharmacy chain, to run drive-through or walk-in test centres. In October 2020, over 1,100 Deloitte consultants were reported to be engaged. In March 2021, the Public Accounts Committee criticised "persistent reliance on consultants", stating that 2,500 were being used at an average cost of £1,100 per day each.
Mobile testing units were designed, prototyped, bought and operated by the Army in April. By 20 July there were 218 in operation in England, Wales and Scotland, and the units were then handed over to undisclosed civilian contractors. Mobile units in Northern Ireland were operated by civilians from the outset.
The system worked in parallel with Public Health England's local health protection teams, who in turn work with local authority staff. Cases involving institutions such as hospitals, care homes and prisons were handed off to the local teams, who gave advice to the institution rather than the affected individuals. Less complex cases were handled by NHS Test and Trace: the infected person was contacted by text, email or phone, and asked to give details of their recent close contacts. They would be able to either enter these contact details into the Test and Trace website, or give them over the phone to a contact tracer. If they did not respond, in some areas NHS Test and Trace passed their details to a team employed by the local authority, who would make further attempts to contact them by phone or text and, in some cases, by home visit.
, there were in excess of 700 testing sites in operation with the stated average distance of travel to reach one at 2.4 miles. All sites operated 7 days a week, including over Christmas and New Year albeit with reduced hours.

Geographic scope

The scope of the NHS Test and Trace contact-tracing service was England only, the other United Kingdom administrations making their own arrangements. However, the laboratory network operated UK-wide.

Budget

The initial budget for 2020–21 was £15bn, of which around 85% was for testing. In November 2020, a further £7bn was allocated as part of the UK government's COVID-19 Winter Plan. £15bn was allocated for the 2021–22 financial year, bringing the total for the two years to £37bn. In February 2022, it was confirmed that the test and trace programme had cost £15.7bn in 2021/22.
After the first phases, Serco were awarded a 12-month contract worth up to £322M in June 2021. A month after the ending of routine contact tracing in February 2022, the company won a two-year contract for disease testing and contact tracing worth a maximum of £212M.

Test processing and 'lighthouse labs'

Test kits for use at home were provided and processed by Randox under a £133M contract, with logistics by Amazon and Royal Mail, and some identity checking by American consumer credit agency TransUnion. Randox had a lab in Northern Ireland, although in May 2020 some samples were processed in the United States owing to lack of capacity. Special arrangements were made with Royal Mail for the return of home testing kits via designated "Priority Postboxes", which were identified by the attachment of special stickers.
Before the COVID-19 pandemic, tests for infections in England were carried out at laboratories within either Public Health England or the NHS. In early April 2020, the government reserved the capacity of these labs for testing NHS patients and staff, calling this "pillar one" of their testing strategy.
"Pillar two" provided mass testing – at first to key workers, later to the general public – using a new network of large processing centres operated by commercial companies and universities, coordinated by Deloitte. Initially three of these sites were planned, at Milton Keynes, Alderley Park and in Glasgow. They were collectively named "lighthouse labs" since they employed the PCR test which uses fluorescent dye to detect the virus. At Milton Keynes, around 240 academics, researchers and students volunteered their services in March and April 2020, in some cases processing tests manually until automation was ready towards the end of April. Geneticist Paul Nurse, director of the Francis Crick Institute, repurposed academic laboratories to perform tests and later criticised the government's reliance on the private sector.
, six sites were in operation:
In November, two further 'mega labs' were announced as due to open in early 2021 at Leamington Spa and an unconfirmed site in Scotland. The Public Accounts Committee found that overall usage of laboratory testing capacity was below 65% in November and December 2020. The Scottish lab was subject to delays and in January its construction was halted, as the UK government was reported to be assessing the long-term demand for the laboratory. Meanwhile, smaller laboratories were opened in Glasgow and Aberdeen during December 2020, but another smaller one planned for Edinburgh had not yet been opened.
Three new laboratories managed by NHS trusts, at Gateshead, Bracknell and Plymouth, joined the system in March 2021. The Leamington Spa lab, described as the UK's first testing mega-lab, began operation in June 2021 and was later named as the Rosalind Franklin Laboratory, in honour of the pioneering scientist in molecular biology.
From 1 April 2022, access to free tests was withdrawn except for high-risk settings and some workers in high-risk roles. Consequently, most of the lighthouse labs were closed. In January 2023, the Rosalind Franklin Laboratory ceased to process PCR tests, leaving two sites operational alongside the NHS laboratories.